Child'S Consent To Adoption
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1
2ONTARIO
Court File Number
(Name of Court)
Form 34: Child’s
at
Consent to Adoption
Court office address
Applicant(s) (The first letter of the applicant’s surname may be used)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
Respondent(s) (If there is a respondent, the first letter of the respondent’s surname may be used)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
1.
My name is
(chid's full legal name)
2.
I was born on
(give date of birth)
3.
I know that the applicant(s) is/are asking the court to make an order to adopt me.
4.
I agree to being adopted by the applicant(s).
5.
I have been given a chance to get counselling.
6.
I understand the nature and effect of this consent. I understand that I may withdraw this consent within 21 days by attending
at the office of the lawyer who witnessed the consent located at
(give address)
or by attending at the office of another authorized representative of the Children’s Lawyer and signing a written notice of
withdrawal.
7.
I understand that once I turn eighteen years old, I can apply for a copy of my original birth registration, if any, and a copy of
my adoption order.
8.
I understand that once I turn nineteen years old, my birth parent(s) can apply for information from my original birth
registration, if any, any substituted birth registration and my adoption order. This information would include my full legal
name after adoption.
who has explained adoption to me,
9.
I have spoken to a lawyer
who has explained what it means for me to sign this consent,
who has told me what to do if I want to change my mind about this consent,
who has told me about my rights and the rights of other persons with respect to the
disclosure of adoption information,
who is going to witness my signing of this form.
To be completed only where the child is 12 years of age or older.
10. I agree that my name after adoption will be
(full legal name after adoption)
Date of signature
signature of child
Signature of Children’s Lawyer
FLR-34-E (2009/04)
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